Prisons have been described as the country's largest residential mental health service, with the Department of Corrections responsible for helping nearly everyone behind bars
New figures reveal the depth of mental health services crisis in prisons, with nearly every prisoner in need of help.
In the year to June 2022 mental health services were delivered for 8,966 people. The latest statistics available for the prison population is that there are 8,120 people behind bars. READ MORE: * Prison visits on the horizon as Corrections staff numbers look set to lift * Clock ticks for mental health response decision
Accounting for churn of the prison population throughout 2022, these figures show most people required support from either the Intervention and Support Practice Teams (ISPT) or a Mental Health Clinical Nurse Specialist.
Corrections Health Services deputy chief executive Juanita Ryan said managing prisoners’ mental health was extremely challenging.
“The mental health services provided in prisons do not replace the services provided by Forensic Mental Health Services, however, while someone is in custody, we make every effort to support and improve their mental wellbeing, ensure their physical safety, and to treat them with dignity and respect.
“We are often required to manage some of New Zealand’s most unwell people in a custodial environment, including, at times, people waiting for a bed in a dedicated forensic mental health facility outside Corrections.”
She said about 60 percent of prisoners would have met the diagnostic criteria for either a mental health or substance abuse disorder within the 12 months prior to imprisonment, and 91 percent would have met these diagnostic criteria at some time over the course of their lives to date.
“In many ways prisons have become our biggest residential mental health service. Because the other parts of the system are just failing so many people.” – Shaun Robinson.
For women in prison, two-thirds have suffered family violence, rape or sexual assault or both, more than 50 percent have post-traumatic stress disorder, and three-quarters have diagnosed mental health problems.
“The disorders, however, often went undetected and were not treated prior to prison.”
Mental Health Foundation chief executive Shaun Robinson said it was a sad indictment that for some people, their first mental health intervention was only once they were already behind bars.
“We need a mental health response across the whole community that hopefully will be providing options for people much earlier, and hopefully that will also contribute to less people ending up in prisons.
“In many ways prisons have become our biggest residential mental health service. Because the other parts of the system are just failing so many people.”
Nearly 1% of those discharged from mental health units end up in prison
Changing Minds chief executive Kevin Harper said the high level of mental health illness and distress in prison was not surprising.
“The social and cultural inequities that drive or are factors in people's mental health and addiction may be related to factors of entering the justice and or prison system, there's a clear crossover.”
In 2018 Changing Minds gathered insights from 760 individuals around Aotearoa to contribute to the Government Inquiry into Mental Health and Addiction.
Harper said people with lived experience identified a desire for a whole of government – and a caring society – approach to mental wellbeing.
“What people want from mental health, generally, is the treatment of the whole person and understanding of the whole person rather than just to condition itself, just a diagnosis.
“And that should continue whether you were in the prison system, health system or elsewhere in any other system.”
What is being done
Juanita Ryan said each new prisoner underwent an induction process, which included an assessment on whether mental health support was required.
“This assessment assists us to determine whether they should be accommodated in an Intervention and Support Unit (ISU) for a period of time.
“A review of an individual’s at-risk status is carried out in a wide range of circumstances including when someone returns from court, following an inter‐prison transfer, if force is used against them, if parole is deferred for two or more years, following a change in family circumstances, confirmation that an individual has been diagnosed with a serious or terminal illness, if they begin to display negative signs or change in mood or behaviour, or if information is received about them that causes staff concern.”
ISUs are also used if prisoners are waiting for a space in an inpatient mental health facility.
In 2017 Corrections received funding to set up Intervention and Support Practice Teams at four prisons.
The teams are multi-disciplinary comprising psychologists, occupational therapists, mental health nurses, social workers, and cultural support workers.
In 2021, the teams were set up at three more prisons.
“It's not just about enough psychologists or counsellors, and it's not just about people being diagnosed with some kind of mental health condition, it is really about people being supported to be healthy human beings." – Shaun Robinson.
Clinical Nurse Specialists (Mental Health) operate at nine prisons where teams are not active.
Ryan said custodial staff working in an Intervention and Support Unit were getting specialised training, while all frontline staff received a mental health 101 training.
“Ara Poutama Aotearoa is currently developing a new 500-bed facility at Waikeria Prison, with an additional 100 beds in a dedicated mental health and addiction service named Hikitia.”
Shaun Robinson said, to its credit, Corrections was one of the more “creative” departments when it came to supporting mental health.
“I was talking to a support worker in Hawkes Bay Prison recently about a very strong tikanga Māori programme that this person works in, which is essentially about reconnecting Māori prisoners with the cultural identity which is having really, really positive impacts and that is also a mental health intervention.”
“It's not just about enough psychologists or counsellors, and it's not just about people being diagnosed with some kind of mental health condition, it is really about people being supported to be healthy human beings.
“That is the fundamentals of mental health.”
